The goal of the project is to plan for implementation and evaluation of a broadly supported safe harbor approach so the state may test whether a safe harbor strategy, brought to bear on carefully chosen clinical issues, will offer incentives powerful enough to lead clinicians to use state-endorsed evidence-based guidelines and will improve population health by reducing the incidence of medical errors and malpractice claims. The specific aims of the project are to: "Set priorities for developing evidence-based guidelines by identifying clinical issues through analysis of medical error and liability claims records." Craft a safe harbor rule defining the legal standard of care in terms of state- endorsed practice guidelines so for the Oregon to adopt. "Develop a plan to evaluate the effectiveness of the change, when enacted. The entire project design takes an evidence-based approach. "The planning process will begin with the applicant, the Patient Safety Commission, and the Center for Evidence-based Policy (1) identifying very specific clinical issues that give rise to frequent or serious medical errors and may result in medical liability claims and payments using medical error reports filed with the Oregon Patient Safety Commission, malpractice claim reports filed with the state, and malpractice claim files of Oregon medical liability insurers and (2) determine whether good evidence exists from which a guideline could be adopted that both clinicians and the public could have confidence would lead to improved outcomes for patients." The applicant will convene a broad stakeholder group, including representatives of the patient safety community and the public, to consider options for details of a safe harbor rule and produce legislative language. "Finally, the applicant will develop a research and evaluation plan to test the hypothesis that the safe harbor rule will reduce injuries and liability costs and take steps to ensure that the data needed for evaluation is collected and reported. PUBLIC HEALTH RELEVANCE: If the planning process is successful, that state will leverage physician desire to avoid medical liability claims and judgments to improve population health. Public health will be improved by increasing provision of evidence-based services and adoption of evidence-based processes of care;reducing the incidence of adverse events associated with diagnosis or treatment by decreasing provision of services that have little or no value compared with alternatives and/or entail unjustifiable health risks;and curbing the growth of per capita health care costs to patients, thereby making health care more accessible to residents and freeing up public resources to expand programs and services in other areas of state assistance.